The pituitary gland, the epicenter of various regulatory hormones, plays an unquestionably important role in determining timely growth and sexual maturation. Indeed, multiple studies have examined the role of Growth Hormone (GH) and Gonadotrophic Releasing Hormone (GnRH) in treating delayed and precocious puberty respectively.[1] Research has shown the importance of imaging the pituitary gland in patients with growth disturbances and/or documented endocrine abnormalities, in differentiating and classifying disorders based on etiology, prognosis and management.[2] Currently, data are limited in identifying a correlation between bone age abnormalities and pituitary findings via MRI, in children diagnosed with deviations in pubertal development. We present a comprehensive review of common structural abnormalities affecting the pituitary as seen on MRI – including developmental (dysgenesis/hypoplasia), traumatic, and neoplastic processes (both benign and malignant) – and how those pituitary lesions correlate with bone age and endocrine function in patients with growth failure and precocious puberty. Establishing a correlation between a patient’s endocrine profile, bone age and pituitary morphology on MRI imaging can be extremely useful in the judicious management of patients, in terms of patient selection, early diagnosis and treatment. Moreover, our review aims to highlight the importance of imaging in the workup of patients with known or suspected growth disturbances, illustrated via concept maps. The concordance of endocrine abnormalities and clinical information (including age, sex and ethnicity demographics) with imaging data will also be reviewed to demonstrate various patterns of disease presentation and diagnosis. <u><b>References:</b></u> [1] Du X.F., Yang X.H., Li J., Hao M., Guo Y.H. Growth hormone co-treatment within a gnrh agonist long protocol improves implantation and pregnancy rates in patients undergoing IVF-ET. Arch. Gynecol. Obstet. 2016;294:877–883. doi: 10.1007/s00404-016-4163-1. [2] Di Iorgi N, Iorgi ND, Allegri AEM et al (2012) The use of neuroimaging for assessing disorders of pituitary development. Clin Endocrinol 76:161–176 Read More

Meeting name: SPR 2019 Annual Meeting & Postgraduate Course , 2019

Authors: Rai Aayushi, Gupta Rachita, Setty Bindu

Keywords: Puberty, Pituitary abnormalities

Educational Objectives: 1. Recognize the utility of a UVC catheter in a neonate 2. Understand the anatomy which guides acceptable positioning of a UVC, and identify helpful radiographic and sonographic landmarks 3. Familiarize readers with common complications of UVC catheters through the use of imaging examples, including: a. Malpositioning/coiling within normal structures b. Hepatic complications c. Cardiac complications 4. Learn to recognize the correlation between radiographic and sonographic appearances 5. Understand the utility of ultrasound in monitoring certain complications Introduction: Umbilical venous catheterization is a common bedside procedure performed in the Neonatal ICU. As with any procedure, umbilical venous catheterization does not come without risks. Understanding the basics of fetal circulation is very important in evaluation of neonatal catheters. Because of the distinct anatomy associated with fetal circulation, there are unique complications associated with UVC placement. The feared complication is placement within the portal venous system, as this may lead to inadvertent infusion of hypertonic fluids such as parenteral nutrition directly into the liver and cause hepatic damage. Radiographs can occasionally reveal findings such as focal lucency corresponding to the area of hepatic necrosis. Ultrasound provides much more detail however and is therefore useful for evaluating and monitoring such complications. While not seen as frequently, cardiac complications may also result from UVC malpositioning. The catheter can sometimes extend too deep and terminate within the right atrium which can lead to perforation and subsequent pericardial effusion leading to cardiac tamponade. In patients with a patent foramen ovale or atrial septal defect, the catheter tip can even end up within the left atrium and lead to cardiac arrhythmias. The purpose of this poster is to illustrate the normal anatomy and catheter positioning, as well as to provide a pictorial review of complications that result from UVC malpositioning. Read More

Meeting name: SPR 2023 Annual Meeting & Postgraduate Course , 2023

Authors: Almeky Somiah, Castro Ilse, Setty Bindu

Keywords: Malposition, NICU, Venous Access

Several ultrasound (US) findings are associated with specific thyroid diseases, but in the vast majority of cases, only a few of these findings are seen. The purpose of this poster is to describe the US findings in a variety of clinically/biopsy-proven thyroid diseases and analyze the frequency of such findings in each of the following diseases. Read More

Meeting name: SPR 2017 Annual Meeting & Categorical Course , 2017

Authors: Malak Wassim, Zhu Jia, Castro-aragon Ilse, Setty Bindu

Keywords: Ultrasound, Thyroid, Pediatrics

To determine if brain MRI is of added value in babies with neonatal abstinence syndrome (NAS) in addition to a head US, and to elucidate the findings observed in each modality. Read More

Meeting name: SPR 2017 Annual Meeting & Categorical Course , 2017

Authors: Farris Chad, Setty Bindu, Mian Asim, Wachman Elisha, Castro-aragon Ilse

Keywords: Brain, Intracranial

Pneumonia is a leading cause of pediatric morbidity and mortality worldwide. In 2017, 15% of under-5 mortalities were due to pneumonia. Children in sub-Saharan Africa are disproportionately affected. Chest radiography (CXR) is currently the reference standard for imaging diagnosis of pediatric lung diseases. However, radiographic equipment is not available in many clinical settings, particularly in low and middle-income countries. In these scenarios, point-of-care lung ultrasound (LUS) is much more readily accessible. Thus, it is important to understand the US appearance of both interstitial and bacterial pneumonias and how they correlate with CXR findings. In this pictorial essay, we will discuss the US appearance of common lower respiratory tract infections such as RSV, COVID-19, and bacterial pneumonia using images obtained from patients ages 1 month to 5 years with symptomatic respiratory illness in Lusaka, Zambia. All images were obtained by a technologist with a Butterfly portable ultrasound probe connected to an iPad. Images were obtained in the anterior, lateral, and posterior lung fields bilaterally. US images will be correlated with CXR findings. The following examples of LUS findings will be discussed: 1) Normal LUS: The pleural line is thin and smooth with normal lung sliding. A-lines are present, and B-lines are limited to less than three in each field of view. 2) Abnormal B-lines: When three or more B-lines are seen in a single field of view, there is an abnormal increase in interstitial fluid. A focal B line is an abnormally thickened B-line and likely represents a confluence of multiple B-lines. 3) White lung: Confluent echogenicity involving two or more rib interspaces. 4) Pleural irregularity: The pleural line is jagged or fragmented and may also appear thickened with small sub-centimeter subpleural consolidations. 5) Pleural effusion: Well-defined fluid above the diaphragm. In a simple transudative effusion, the fluid appears anechoic. In a complex exudative effusion, the fluid may have loculations, septations, and/or internal echogenic floating debris. 6) Consolidation: Poorly defined, tissue-like region within the lung, usually seen adjacent to the pleural line. 7) Lung necrosis or abscess: Well-defined, hypoechoic region within an area of consolidation. By understanding the US appearance of lung pathologies, LUS can be used to diagnose pediatric lung diseases in areas where CXRs are currently unavailable. Read More

Meeting name: SPR 2022 Annual Meeting & Postgraduate Course , 2022

Authors: Chang Hailey, Gill Christopher, Setty Bindu, Castro-aragon Ilse, Camelo Ingrid, Etter Lauren, Pieciak Rachel, Thompson Russell, Wang Kaihong, Li Jason

Keywords: Lung Ultrasound, RSV, Pneumonia

Point of Care Lung ultrasound has proven in multiple studies to be superior to CXR to diagnose pneumonia in children especially in limited resource settings. This non-radiating, portable and adaptable technique, brings an opportunity to detect pneumonia with higher accuracy than CXR. Ultrasound imaging interpretation is challenging. To deal with this complexity, we created a "brightness profiles" data reduction technique to identify specific anatomical structures identified by lung ultrasound using artificial intelligence. We use this technique to demonstrate how data reduction can help identify common anatomical landmarks and abnormal findings, and aid in the interpretation of ultrasound diagnosed pediatric pneumonia. Read More

Meeting name: SPR 2022 Annual Meeting & Postgraduate Course , 2022

Authors: Li Jason, Betke Margaret, Gill Christopher, Thompson Russell, Wang Kaihong, Etter Lauren, Camelo Ingrid, Chang Hailey, Setty Bindu, Castro Ilse, Pieciak Rachel

Keywords: Artificial intelligence, pneumonia, ultrasound

CXR is the most common imaging method to diagnose pneumonia in children in limited-resource settings. There is a need to simplify and expedite its interpretation. By using a machine learning model to first classify and interpret the pneumonia images and then incorporate those characteristic imaging findings patterns into a simulated mobile app, health care workers can use their mobile devices to interpret those findings based on preloaded images built into their mobile devices corresponding to pneumonia. Read More

Meeting name: SPR 2022 Annual Meeting & Postgraduate Course , 2022

Authors: Thompson Russell, Pieciak Rachel, Gill Christopher, Li Jason, Wang Kaihong, Etter Lauren, Camelo Ingrid, Castro-aragon Ilse, Setty Bindu, Chang Hailey, Betke Margaret

Keywords: Artificial intelligence, pneumonia, CXR